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08/17/2011

Jenny is an asshole, and so, of course, am I

Ha, poor "Jenny" from Sunday's New York Times Magazine article on selective reduction in twin pregnancies after ART. I imagine her reading the opening paragraphs of the piece:

As Jenny lay on the obstetrician's examination table, she was grateful that the ultrasound tech had turned off the overhead screen. She didn't want to see the two shadows floating inside her. Since making her decision, she had tried hard not to think about them, though she could often think of little else. She was 45 and pregnant after six years of fertility bills, ovulation injections, donor eggs and disappointment — and yet here she was, 14 weeks into her pregnancy, choosing to extinguish one of two healthy fetuses, almost as if having half an abortion. As the doctor inserted the needle into Jenny's abdomen, aiming at one of the fetuses, Jenny tried not to flinch, caught between intense relief and intense guilt.

As she reads, she feels her stomach sink, her breathing grow shallow, her heart thumping hard in her chest.  She continues:

"Things would have been different if we were 15 years younger or if we hadn’t had children already or if we were more financially secure," she said later. "If I had conceived these twins naturally, I wouldn't have reduced this pregnancy, because you feel like if there's a natural order, then you don't want to disturb it. But we created this child in such an artificial manner — in a test tube, choosing an egg donor, having the embryo placed in me — and somehow, making a decision about how many to carry seemed to be just another choice. The pregnancy was all so consumerish to begin with, and this became yet another thing we could control."

At this, she slowly lowers the paper and folds it, slowly, deliberately.  Dazed, she wanders into the bathroom, where, under the harsh light of new awareness, she looks at her pallid face in the mirror and whispers, "Holy shit. I'm such an asshole."

I've now read the article three or four times, just to be sure I get the point of it, and I'm still not completely certain I do.  I've read numerous reactions to it, though I haven't read the comments on the piece itself — do I look like an asshole? No, I mean that particular kind of asshole — and although I understand some of the outrage I've seen, I don't share the perspective that might reasonably give rise to it.  A parent of twins, for example, or an ART patient who would welcome them, or someone willing to risk conceiving multiples to maximize her chance of success, necessarily has a different viewpoint than mine.  (For the record, mine was No oh please God no, so much so that during the donor cycle that resulted in Ben, we transferred a single embryo.)

The reactions I've read are largely visceral; many people report that they couldn't finish reading the article, so distasteful was the proposition of terminating half of a twin pregnancy for what the author calls "social indications" — concerns about money, say, or "becoming a second-rate parent." (Jenny feared "twins would soak up everything she had to give, leaving nothing for her older children." Twins: the quicker picker-upper!)  Some felt that by having taken on on the risk of multiples to begin with, Jenny and others like her should live with the consequences — a familiar hard-liner argument in the case of high-order multiples, but a startling one coming, in this case, from what I think of as "our side."

To me, though, that wasn't the most compelling point, how lamentable and/or monstrous and/or A-OK and/or Jenny-is-an-asshole we find such an action to be.  In fact, those reactions were a good example of what struck me hardest about the article: how mutable, how situational, how conditional our feelings are about abortion.

How many times have you heard someone describe him or herself as opposed to abortion exceptincasesofrapeorincest?  Compare the sympathy you might have felt for the young woman working her way through college who gets pregnant unexpectedly while on contraception to the indignation that arises when you hear of someone fresh from her fifth abortion.  Or, to bring this back to ART and the story at hand, think about how differently we view a selective reduction from quadruplets to twins from a reduction from twins to a singleton — 50% in either case.  What's interesting to me is not specifically what any of these women have done; it's that our reaction to their actions changes radically based on how "necessary" we believe them to have been.

It struck me pretty forcibly how reluctant the article's subjects were to call what they did abortion.  When Jenny chooses to terminate one of her fetuses, it's characterized as "almost as if having half an abortion."  Shelby, who conceived triplets after an IUI, couldn't find a local doctor who'd reduce her pregnancy past twins, and said, "I just wanted [the pregnancy] out, but because we tried for so long, abortion wasn't an option." (She later flew to New York for the reduction to a singleton.)  Almost as ifHalf an abortion? Abortion wasn't an option?  Another illustration, I think, of the motive — intentionally becoming less pregnant rather than not at all pregnant — being more central to the way we think about these things than the nature of the act itself.

I was remembering a conversation I had with my doctor when we first started trying to conceive a second child.  Charlie's birth was still a fresh horror, and I'd been told by my maternal/fetal medicine doctor that the very best way to avoid it was not to have another child, you big dope, but because I am equal parts brave, stubborn, and stupid, we decided to pursue merely the second-best way to avoid it.  "I don't want twins," I told my doctor.

And he said a few unflattering things about my egg quality, like, Doctor, I am sitting right here, and how I'd be lucky to get two eggs out of a single cycle, much less two embryos, but that my chances would be diminished by transferring only one.  And I hedged a bit, saying that I might be willing to transfer two, depending on quality, meaning maybe two if they were crappy.

"But then you might get pregnant with twins," he pointed out.  "What would you do?"

"I'd reduce," I said.

"It's not an easy choice," he said.

"I'd do it, though," I told him simply, sounding either totally badass or totally unhinged, one.  (Only later did I remember he had twins himself.  My money's on unhinged, and dangerously cold.  And a Jenny-grade asshole besides.)

And I would have, for medical reasons.  And there are people who would look at that statement and say, Okay, well, but that's different.  You'd have had a good reason.  A twin pregnancy could have killed you.  And that's exactly the point: how we feel about the act stems directly from how we feel about the reasons.  Except for the staunchest absolutists, it seems we judge reproductive choices based on the motives behind them.

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